小血管临时转流的实验研究与临床应用  

The experimental study and clinical application of temporary intravascular shunt on small blood vessels

作　　者：黄喜军[1] 王东[1] 郑灿镔[1] 索朗[1] 李家春[1] 周翔[1] 朱庆棠[1] 顾立强[1] 刘小林[1] 

机构地区：[1]中山大学附属第一医院显微创伤骨科,广州510080

出　　处：《中华显微外科杂志》2014年第3期258-262,共5页Chinese Journal of Microsurgery

基　　金：卫生部行业资金项目（201402016）

摘　　要：目的探讨临时性血管转流术用于小血管转流的可行性，研究转流管长度对维持通血时间的影响，观察小血管临时性转流术的临床效果。方法20只新西兰大白兔随机分为A、B两组，制成右侧股动脉离断模型，用内径为2．0mm的转流管桥接于血管断端，A、B组转流管的长度分别为10cm和20cm。术后定期观察转流管通畅性，观察终点为转流管变为暗红色，超声探测无血流信号，远端动脉搏动消失，即转流管完全堵塞。比较两组到达观察终点的时间有无差异。临床上用相同材料内径为3．0mm转流管分别为1例前臂Gustilo ⅢC型骨折患者和1例断腕再植患者桥接离断的桡动脉两端，形成临时转流，观察转流管的使用效果。结果大白兔股动脉口径1．5—2．0mm，建立血管转流后可见转流管及其远端的股动脉有搏动，超声多普勒可检测到转流管内有血流信号，随着时间的延长，转流管逐渐由鲜红色变为暗红色，远端血管搏动逐渐减弱直至消失，血流信号消失，A、B两组到达观测终点的时间分别为（240．0±122．78）（117．0—363．0）rain和（230．0±109．20）（121．0—339．0）min，两者比较其差异无统计学意义（P〉0．05）。临床行桡动脉临时转流2例，转流时间分别为180min和148min。建立血管转流后，肢端血供恢复，取出转流管时，转流管仍保持通畅，术后远端肢体成活。结论临时性血管转流术可用于口径1．5～2．0mm的小血管转流，维持通血时间可达4h，使用长度为10．0cm与20．0cm的转流管，其维持通血时间无显著差别。断腕再植时采用小血管临时性转流术可早期重建远端血供，缩短肢体缺血时间。Objective To investigate the feasibility of temporary intravascular shunt （TIVS） using on small blood vessels and the relation between the length of TIVS and the time of the patency, then observe clinical results of TIVS. Methods The right femoral artery transection model were established in 20 New Zealand white rabbits, which were divided into group A and B （n = 10） randomly. The vascular stumps were bridged by the shunts with 2 mm in inner diameter, with the shunts in length in group A and B being 10 cm and 20 cm respectively. Regular observation was carried out after operation for the patency in shunts. The observation endpoint with the shunts completely blocked were as follows ： the color of shunts turn into a dark red, no blood flow on Doppler ultrasound testing, no pulse in distal artery. The differences between two groups to reach the end of the time observed. The results on repairing radial artery with TIVS with 3 mm in inner diameter for patients of Gustilo Ⅲ C-type fractures in forearm and broken wrist reimplantation were observed. Results The diameter of the femoral artery of rabbits was 1.5-2. 0 mm. After vascular bypass were established, there were pulse in the distal femoral artery and flow signal in shunts could be detected by Doppler ultrasound. With the passage of time, the shunts were gradually from bright red to dark red, distal pulse gradually weakened until it disappears, and the blood flow signal disappears eventually. The time reach observation endpoint in groups A, B were （240. 00 ± 122. 78） （117.00-363.00） min and（230. 00 ± 109. 20） （121.00-339.00） min respectively. The difference between the two was not statistically significant. There were 2 clinical cases using TIVS for radial artery, and the bypass time were 180 min and 148 min. After establishing vascular bypass, peripheral blood supply were restored, the vessels remained patency after remove the shunts, distal limbs postoperative were survived. Conclusion Temporary vascular bypass could use for small bl

关 键 词：临时性血管转流术 四肢血管损伤 开放骨折 兔 血管桥接 

分 类 号：R68[医药卫生—骨科学]